Latest PATH Findings: E-Cigarette Use Increasing, But Less Likely To Lead To Long-Term Habit

BUFFALO, N.Y. — A team from Roswell Park Comprehensive Cancer Center contributed to a group of 10 interrelated studies on tobacco use that shed light on key usage patterns and offered a surprising finding about e-cigarette use. The studies — published in Tobacco Control, the leading international journal for tobacco scientists — culminated a major collaborative effort to document detailed tobacco use for the ongoing Population Assessment of Tobacco and Health (PATH) Study, the largest prospective study on tobacco use undertaken by the National Institutes of Health (NIH) and the Food and Drug Administration (FDA), which began in 2013.

These latest analyses, using data collected during the period from 2013 to 2016, revealed an unexpected discovery.

Dr. Andrew Hyland

Scientific lead on the PATH Study

“The most surprising finding was that while we know cigarette smoking is persistent, and we see use of electronic cigarettes, or e-cigarettes, increasing, especially among young people, what we are not seeing is that e-cigarette use is anywhere near as persistent as cigarette smoking,” says Andrew Hyland, PhD, Chair of Health Behavior at Roswell Park and scientific lead on the PATH Study. “Cigarette smokers tend to stay cigarette smokers over time, but e-cigarette users are more likely to discontinue their use over time compared with cigarette smokers. We don’t know why that is.”

While both products typically contain nicotine, Dr. Hyland notes, it could be that cigarettes deliver nicotine more effectively than e-cigarettes. Studies have shown that the types of e-cigarettes used during 2013 to 2016 didn’t deliver nicotine as efficiently as cigarettes.

Other key findings from this collection of studies:

• Cigarette smoking remains the most persistently used tobacco product in the United States — for both youth and adults — with most cigarette smokers continuing to smoke across time. Across the nation, 60% of youth, 68% of young adults and 82% of adult cigarette smokers persisted in cigarette smoking across two years.
• While the prevalence of cigarette smoking decreased from 5% to 3% among youth and from 29% to 26% among young adults, it remained around 21% for adults across the same time period. Overall, cigarettes remain the tobacco product most commonly used in the U.S.
• The majority of hookah and cigar users in the U.S. stopped using these products in a couple of years, whereas smokeless tobacco users tended to persist more in using smokeless tobacco products across that time; 49% of youth, 52% of young adults, and 67% of adult smokeless tobacco users persisted in their use.
• Among adult smokers in the U.S., e-cigarette use is associated with attempting to quit cigarette smoking. E-cigarette users were 20% more likely to try quitting cigarette smoking than adult smokers who did not use e-cigarettes.

Nicotine dependence remains a key barrier to quitting among tobacco users, and a key risk factor for relapsing back to smoking. Adults who smoke cigarettes every day are half as likely as non-daily smokers to quit smoking. And former tobacco users who experience greater cravings to use tobacco are more likely to relapse than former users with fewer symptoms.

While the majority of e-cigarette users did not persist in their e-cigarette use over the period from 2013 to 2016, today’s e-cigarettes deliver higher doses of nicotine and use improved chemistry to more efficiently deliver nicotine to users. Those changes, and the addition of flavors, may be why more recent data show a significant increase of e-cigarette usage among young people since 2017.

“A big question is whether people who use these newer vaping products can get addicted to them at the same rate as people get addicted to cigarettes,” says Karin Kasza, PhD, a Research Scientist in the Department of Health Behavior at Roswell Park and lead author of several of the studies. “More research is needed to answer this important question.”

Unlike cigarette smokers, e-cigarette users are more transient, and often stop using or switch to other products. From 2013 to 2016, e-cigarette usage among youth and young adults was less persistent than traditional cigarette usage, with only 27% of adults persisting in use, compared to 82% of adult cigarette smokers.

Prevalence of e-cigarette use also remained lower across the two-year period for young adults and adults — 17% for young adults and 6% for adults, compared with 26% for young adults and 21% for adults among cigarette smokers.

Data from these published studies will help researchers analyze questions about whether e-cigarettes help people quit smoking cigarettes or whether they provide a gateway to cigarette smoking, Dr. Kasza says. And they will allow scientists to examine complex factors regarding how nicotine, flavors and product chemistry together produce different effects for different people.

“More work is needed to understand all that, but one thing is clear: Cigarette smoking is addictive and persistent and hard to stop once you start,” Dr. Hyland says.

Maansi Bansal-Travers, PhD, a Research Scientist in the Department of Health Behavior at Roswell Park, is a co-author of the studies, which also included work by tobacco scientists from the FDA, the National Institute on Drug Abuse (NIDA) and Westat. Federal funds from NIDA, the NIH and the Center for Tobacco Products within the FDA, under contract to Westat (contract no. HHSN271201100027C), supported this work.

An overview article is here and the full collection of papers can be accessed here.

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